GI Treatment Planning & Management 2 — Questions and Answers
Question 1: A patient with Crohn's disease has failed mesalamine therapy. What is the most appropriate next step in management?
- Increase mesalamine dose
- Initiate corticosteroid therapy (Correct answer)
- Proceed directly to surgical resection
- Start probiotic supplementation
Correct answer: Initiate corticosteroid therapy
When 5-ASA agents like mesalamine fail in Crohn's disease, corticosteroids are the standard next step to induce remission.
Question 2: Which antibiotic combination is the first-line treatment for Helicobacter pylori eradication in the US?
- Amoxicillin + metronidazole
- Clarithromycin + amoxicillin + a PPI (Correct answer)
- Doxycycline + bismuth
- Ciprofloxacin + metronidazole + PPI
Correct answer: Clarithromycin + amoxicillin + a PPI
Triple therapy with clarithromycin, amoxicillin, and a PPI remains standard first-line H. pylori eradication in low-resistance areas.
Question 3: A cirrhotic patient develops ascites for the first time. What is the initial management strategy?
- Paracentesis immediately
- Sodium restriction and spironolactone (Correct answer)
- TIPS procedure
- Liver transplant evaluation only
Correct answer: Sodium restriction and spironolactone
First-line management of new ascites in cirrhosis is sodium restriction combined with spironolactone as the preferred diuretic.
Question 4: What is the recommended surveillance interval for colonoscopy after removal of a single tubular adenoma < 10 mm with low-grade dysplasia?
- 1 year
- 3 years
- 5–10 years (Correct answer)
- No further surveillance needed
Correct answer: 5–10 years
Current guidelines recommend repeat colonoscopy in 5–10 years after removal of a low-risk adenoma (single, small, low-grade dysplasia).
Question 5: A patient with ulcerative colitis in remission is maintained on 6-mercaptopurine. She wants to become pregnant. What is the recommended approach?
- Discontinue 6-MP immediately before conception
- Continue 6-MP as it is considered relatively safe in pregnancy (Correct answer)
- Switch to methotrexate
- Perform colectomy before attempting pregnancy
Correct answer: Continue 6-MP as it is considered relatively safe in pregnancy
6-mercaptopurine is considered relatively safe during pregnancy and maintaining disease remission is prioritized to avoid flares.
Question 6: Which class of medication is the cornerstone of chronic Hepatitis C treatment in current clinical practice?
- Interferons
- Nucleoside analogue monotherapy
- Direct-acting antivirals (DAAs) (Correct answer)
- Ribavirin monotherapy
Correct answer: Direct-acting antivirals (DAAs)
Direct-acting antivirals have revolutionized HCV treatment, achieving cure rates >95% with short, well-tolerated regimens.
Question 7: A patient with symptomatic gallstones and no contraindications presents for management. What is the definitive treatment?
- Ursodeoxycholic acid dissolution therapy
- Lithotripsy
- Laparoscopic cholecystectomy (Correct answer)
- Low-fat diet alone
Correct answer: Laparoscopic cholecystectomy
Laparoscopic cholecystectomy is the definitive and preferred treatment for symptomatic cholelithiasis.
GI Treatment Planning & Management 2
A patient with Crohn's disease has failed mesalamine therapy.
What is the most appropriate next step in management?